Hepatitis C position statement

Physicians who work in correctional institutions have an obligation to provide medically necessary care for their patients. The treatment of hepatitis C is advancing rapidly with new treatments utilizing medications that are more efficacious but also more expensive. It is the obligation of the correctional physician to use evidence-based criteria to identify those patients who would benefit most from these new medications and to advocate for their treatment. Correctional systems must not prohibit the new medications based solely on price. They must balance the available resources to treat hepatitis C without compromising the delivery of care for other medical conditions.

As physicians who care for patients who are incarcerated, we have the same obligation as all physicians to utilize the most appropriate medications to cure treatable conditions and to practice within the prevailing standard of care. New medications are now available to cure hepatitis C and possibly prevent eventual liver failure. As with many new treatments in medicine, the initial expense of the technology may call into question whether the treatments should be utilized and when it should be implemented. We have individuals in our care whose medical condition cannot wait for that debate to resolve and we have an obligation to treat them before their medical disease progresses beyond the point of treatment. Consequently, price should not be the sole factor to deny initiation of a medically-necessary course of treatment with a direct-acting agent against Hepatitis C.

With thirty percent of the total U.S. population with hepatitis C spending time in a correctional facility each year, correctional facilities are in a unique position to identify and treat patients infected with hepatitis C. Furthermore, correctional facilities have the medical and social infrastructure to enable effective hepatitis C care. Correctional patients often have a better chance of successful treatment during their time of incarceration than they have in the community where outside stressors, addiction issues, and potential lapses in access to care can compromise the patient’s best chance for a cure.

As the country contemplates the potential public-health benefits of widespread hepatitis C eradication across the population, the Society of Correctional Physicians stands ready to participate as an eager partner in the evolution of hepatitis C management. Currently the upfront cost of the medications is beyond what could be implemented broadly across the entire infected population. Until the public health issues are resolved and until funding is available at a level necessary to broaden the treatment group, correctional physicians are obliged to prioritize which patients qualify for medically necessary treatment of hepatitis C. For now, treatment of this medically necessary group must be reasonably considered and provided without sacrificing the medically necessary care for all of the other medical conditions in our patient population.

If correctional facilities are enlisted to help eradicate hepatitis C within the population, we must be allocated adequate resources to implement the goal in a medically responsible way, including funding for disease surveillance, screening, medically appropriate evaluation and complete disease treatment. The benefit of any broad public health campaign is often realized by society years after individual patients are treated. We are part of the solution to this epidemic but we recognize that we cannot treat in isolation and we cannot shoulder the cost of fighting hepatitis C alone.